An analysis of the demand for primary care physicians in the Sallisaw, Oklahoma, medical service area

An Analysis of the Demand for Primary Care Physicians in the Sallisaw, Oklahoma, Medical Service Area
Rural Development
Oklahoma Cooperative Extension Service
Oklahoma State University
Oklahoma Office of Rural Health
Rural Health Policy & Research Center
Oklahoma State University
October 2010 AE-10118
An Analysis of the Demand for Primary Care Physicians
in the Sallisaw, Oklahoma, Medical Service Area
Brian E. Whitacre, Assistant Professor and Extension Economist, OSU, Stillwater
405-744-6083; FAX 405-744-9835
Lara Brooks, Assistant Extension State Specialist, OSU, Stillwater
405-744-6083
Gerald A. Doeksen, Regents Professor and Extension Economist, OSU, Stillwater
405-744-6083
Tony Yates - Sequoyah County Extension Director, Sallisaw
(918) 775-4838
Jack Frye - District Rural Development Specialist, Ada
(580) 332-4100
Corie Kaiser, Assistant Director, Oklahoma Center for Rural Health, Oklahoma City
405-840-6500
Val Schott - Director, Oklahoma Center for Rural Health, Oklahoma City
405-840-6500
Rural Development
Oklahoma Cooperative Extension Service
Oklahoma State University
Oklahoma Office of Rural Health
Center for Rural Health
Oklahoma State University
October 20101
An Analysis of the Demand for Primary Care Physicians
in the Sallisaw, Oklahoma, Medical Service Area
Introduction
This report will examine the need for primary care physicians in the Sallisaw, Oklahoma, Medical Service Area. Primary care physicians include internal medicine physicians, family practitioners, obstetrics-gynecologists, and pediatricians. Specifically, the study will:
1. Determine the medical service area and population;
2. Estimate primary care physician office visits; and
3. Estimate the total demand for primary care physicians in the medical service area.
No recommendations will be made. The information included in this report is designed to assist local decision-makers in assessing the need and potential for primary care physician services.
Determining Need for Primary Care Physicians
in the Sallisaw, Oklahoma, Medical Service Area
In order to estimate the number of visits to primary care physicians in Sallisaw, the medical service area was delineated as shown in Figure 1. To determine the medical service area, a number of factors were taken into consideration, including the proximity of physician practices in nearby cities and the travel distances faced by residents of nearby communities. In particular, existing physician practices in the surrounding communities, (Stigler, Stilwell, Ft. Smith, AR, Poteau, and Muskogee) likely draw residents of those nearby communities. Therefore, the primary medical service area for Sallisaw includes Sallisaw, Muldrow, and Vian while the secondary medical service area is comprised of Gore and Roland since there is the possibility that some individuals in these towns will choose to go to Sallisaw for their physician needs. The 2009 estimated population of the primary medical service area was 31,457 as shown 2
in Table 1. The 2009 estimated secondary medical area population totals to 10,351. This yields a total population of 41,808 for both the primary and secondary service areas.
Hospital
County
Number of Beds
Memorial Hospital
Adair
46
Tahlequah City Hospital
Cherokee
100
Summit Medical Center
Crawford, AR
103
Haskell County Community Hospital
Haskell
25
Eastern Oklahoma Medical Center
LeFlore
84
Muskogee Community Hospital, LLC
Muskogee
45
Muskogee Regional Medical Center
Muskogee
255
Sparks Regional Medical Center
Sebastian, AR
510
St. Edward’s Mercy Medical Center
Sebastian, AR
336
Figure 1
Sallisaw, Oklahoma Medical Service Area
Secondary Service Area
Primary Service Area 3
Table 1
Sallisaw, Oklahoma Medical Service Area Population by Zip Code
Estimated 2009 Population
Totals
Primary Medical Service Area
74955, Sallisaw
13,689
74948, Muldrow
10,510
74962, Vian
7,258
31,457
Secondary Medical Service Area
74435, Gore
1,478
74954, Roland
8,873
10,351
Medical Service Area Total
41,808
Source: ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions
The number of physician office visits generated in the Sallisaw, Oklahoma service area was estimated using the service area population data and research on the number of annual physician office visits for a specified age group [1, 2, 3]. Age group breakouts (by gender) and their corresponding number of annual physician office visits are presented in Table 2. For instance, for males under age 15, the average number of physician office visits is 2.6 visits per year [3]. Males between 15 and 24, however; make only 1.1 visits per year. Similar estimates are applied to other age groups to derive the total number of physician office visits occurring in the Sallisaw medical service area. Residents in the primary medical service area were estimated 4
to make 99,227 total physician office visits per year, while residents of the secondary medical service area were estimated to visit physicians 33,172 times annually (Table 2). Of these total physician office visits, recent data indicates that 58.3 percent will be made to physicians active in primary patient care while the remainder will be made to specialists [3]. Using the data presented in Table 2, the primary medical service area will generate 57,850 primary care physician visits (58.3% x 99,227), and the secondary medical service area will generate 19,339 visits (58.3% x 33,172) yielding a total of 77,189 local primary care physician visits per year for the total medical service area.
The total number of primary care physician office visits given various usage rates is presented in Table 3 for the Sallisaw medical service area. If there is a 90 percent usage of Sallisaw primary care physicians by residents of the primary medical service area and a 10 to 15 percent usage rate from residents in the secondary service area, an estimated 53,999 to 54,966 primary care physician office visits will be made annually in the Sallisaw medical service area. The national average for the number of annual office visits to each primary care physician is 4,870 [4]. Therefore, Sallisaw needs an estimated 11.1 primary care physicians at a 90 percent primary medical service area usage rate coupled with a 10 percent usage rate from the secondary medical service area (53,999/4,870 = 11.088). By expanding the secondary usage rate to 15 percent, the need becomes 11.3 total primary care physicians (54,966/4,870 = 11.287). Higher usage levels would indicate that more physicians could be supported, while lower usage levels would indicate fewer physicians could be supported.
All assumptions and local conditions, including the actual usage levels in the primary and secondary medical service areas must be taken into consideration by decision-makers before determining if additional physicians could successfully locate in Sallisaw, Oklahoma. Some Sallisaw residents may be hesitant to leave their current physician, even if they are in another 5
town. Further, the current number of existing primary care physicians is not included in this analysis. Any evaluation of the relative shortage or surplus of primary care physicians must include details about the current levels of practicing physicians. Again, primary care physicians include the physician practices of internal medicine, pediatrics, family medicine, and OB-GYN. All of these types of physicians should be considered when analyzing the usage levels in the medical service area.
Summary
The analysis above presented the methodology and results of estimating the demand for primary care physicians in Sallisaw, Oklahoma. The results suggest that, given a 90% primary service area usage rate and a 10% secondary service area usage rate, an estimated 11.1 primary care physicians can be supported in the Sallisaw area. The actual number of physicians that the Sallisaw medical service area can support will vary based on the usage rates depicted in Table 3. Estimates of these usage rates should be used in conjunction with the current status of the primary care industry in Sallisaw to determine the next steps for the community.
Many assumptions have been made in this analysis. These include items that may change, such as the population of the service area or service area delineation. For example, the service area depicted here may change due to the exit or entry of physicians from nearby communities. If this does occur, revised estimates of physician office visits should be made. The number of existing primary care physicians is not addressed in this study. A close examination of current practicing primary care physicians will be imperative to accurately assess whether or not the current population base can in fact support additional primary care physicians.
All assumptions should be closely examined by local decision-makers to verify that they reflect local conditions. If additional local data are available, they should be included to derive the 6
most realistic conclusion possible for the current situation. If further analysis is needed, contact your county extension office listed on the title page of this document.7
Table 2
Annual Primary Care Physician Office Visits Generated in the Sallisaw, Oklahoma, Medical Service Areas
PRIMARY MEDICAL SERVICE AREA
Male
Female
2009
Visit
2009
Visit
Total
Age
Population
Rate1
Visits
Population
Rate1
Visits
Visits
Under 15
3,311
2.6
8,608
3,185
2.6
8,281
16,890
15-24
2,418
1.1
2,659
2,167
2.4
5,201
7,860
25-44
4,115
1.6
6,584
4,083
3.2
13,065
19,649
45-64
3,869
3.0
11,608
4,066
3.9
15,858
27,467
65-74
1,041
5.5
5,723
1,222
6.0
7,332
13,055
75+
748
7.1
5,314
1,232
7.3
8,993
14,307
Total
15,502
40,497
15,955
58,731
99,227
Primary Medical Service Area - Local Primary Care Physician Office Visits Per Year:
57,850
SECONDARY MEDICAL SERVICE AREA
Male
Female
2009
Visit
2009
Visit
Total
Age
Population
Rate1
Visits
Population
Rate1
Visits
Visits
Under 15
1,089
2.6
2,833
1,048
2.6
2,725
5,558
15-24
796
1.1
875
713
2.4
1,711
2,586
25-44
1,354
1.6
2,166
1,344
3.2
4,299
6,466
45-64
1,273
3.0
3,820
1,338
3.9
5,218
9,038
65-74
342
6.2
2,123
402
6.7
2,694
4,817
75+
246
7.1
1,749
405
7.3
2,959
4,708
Total
5,101
13,565
5,250
19,607
33,172
Secondary Medical Service Area - Local Primary Care Physician Office Visits Per Year:
19,339
Source: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center of Health Statistics, "National Ambulatory Medical Care Survey: 2006 Summary," No. 3, August, 2008
8
Table 3
Primary Care Physician Office Visits Given Usage
By Local Residents in Sallisaw, Oklahoma Medical Service Areas
Usage by Residents of Primary Service Area
70%
75%
80%
85%
90%
95%
100%
Usage by Residents of Secondary Service Area
5%
41,462
44,354
47,247
50,139
53,032
55,924
58,817
10%
42,429
45,321
48,214
51,106
53,999
56,891
59,783
15%
43,396
46,288
49,181
52,073
54,966
57,858
60,750
20%
44,363
47,255
50,148
53,040
55,932
58,825
61,717
25%
45,330
48,222
51,114
54,007
56,899
59,792
62,684
30%
46,297
49,189
52,081
54,974
57,866
60,759
63,651
35%
47,263
50,156
53,048
55,941
58,833
61,726
64,618
40%
48,230
51,123
54,015
56,908
59,800
62,693
65,585
45%
49,197
52,090
54,982
57,875
60,767
63,660
66,552
50%
50,164
53,057
55,949
58,842
61,734
64,627
67,519
If 90% primary medical service area and 10to 15% secondary medical service area, then the usage would be:
9,557 to 11,035 total primary care physician office visits
for an estimated 11.1 to 11.3 Total Primary Care Physicians
Based on 4,870 average annual primary care office visits per physician practice in Oklahoma [4] 9
References
[1] “Family Medicine – A Systematic Approach to the Planning and Development of a Community Practice,” Doeksen, G., Miller, K.A., Shelton, P.J., and Miller, D.A., University of Oklahoma Health Sciences Center, 1990.
[2] "Internal Medicine - A Systematic Approach to the Planning and Development of a Community Practice - A Step-by-Step Guide," Miller, K.A., Doeksen, G., Miller, D., Campbell, J., and Shelton, P.J., University of Oklahoma Health Sciences Center, 1993.
[3] U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center of Health Statistics, "National Ambulatory Medical Care Survey: 2006 Summary," No. 3, August, 2008.
[4] Physician Socioeconomic Statistics. American Medical Association, Center for Health Policy Research. Eds Wassenaar, JD, and SL Thran. 2003. American Medical Association: United States.
[4] ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.

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An Analysis of the Demand for Primary Care Physicians in the Sallisaw, Oklahoma, Medical Service Area
Rural Development
Oklahoma Cooperative Extension Service
Oklahoma State University
Oklahoma Office of Rural Health
Rural Health Policy & Research Center
Oklahoma State University
October 2010 AE-10118
An Analysis of the Demand for Primary Care Physicians
in the Sallisaw, Oklahoma, Medical Service Area
Brian E. Whitacre, Assistant Professor and Extension Economist, OSU, Stillwater
405-744-6083; FAX 405-744-9835
Lara Brooks, Assistant Extension State Specialist, OSU, Stillwater
405-744-6083
Gerald A. Doeksen, Regents Professor and Extension Economist, OSU, Stillwater
405-744-6083
Tony Yates - Sequoyah County Extension Director, Sallisaw
(918) 775-4838
Jack Frye - District Rural Development Specialist, Ada
(580) 332-4100
Corie Kaiser, Assistant Director, Oklahoma Center for Rural Health, Oklahoma City
405-840-6500
Val Schott - Director, Oklahoma Center for Rural Health, Oklahoma City
405-840-6500
Rural Development
Oklahoma Cooperative Extension Service
Oklahoma State University
Oklahoma Office of Rural Health
Center for Rural Health
Oklahoma State University
October 20101
An Analysis of the Demand for Primary Care Physicians
in the Sallisaw, Oklahoma, Medical Service Area
Introduction
This report will examine the need for primary care physicians in the Sallisaw, Oklahoma, Medical Service Area. Primary care physicians include internal medicine physicians, family practitioners, obstetrics-gynecologists, and pediatricians. Specifically, the study will:
1. Determine the medical service area and population;
2. Estimate primary care physician office visits; and
3. Estimate the total demand for primary care physicians in the medical service area.
No recommendations will be made. The information included in this report is designed to assist local decision-makers in assessing the need and potential for primary care physician services.
Determining Need for Primary Care Physicians
in the Sallisaw, Oklahoma, Medical Service Area
In order to estimate the number of visits to primary care physicians in Sallisaw, the medical service area was delineated as shown in Figure 1. To determine the medical service area, a number of factors were taken into consideration, including the proximity of physician practices in nearby cities and the travel distances faced by residents of nearby communities. In particular, existing physician practices in the surrounding communities, (Stigler, Stilwell, Ft. Smith, AR, Poteau, and Muskogee) likely draw residents of those nearby communities. Therefore, the primary medical service area for Sallisaw includes Sallisaw, Muldrow, and Vian while the secondary medical service area is comprised of Gore and Roland since there is the possibility that some individuals in these towns will choose to go to Sallisaw for their physician needs. The 2009 estimated population of the primary medical service area was 31,457 as shown 2
in Table 1. The 2009 estimated secondary medical area population totals to 10,351. This yields a total population of 41,808 for both the primary and secondary service areas.
Hospital
County
Number of Beds
Memorial Hospital
Adair
46
Tahlequah City Hospital
Cherokee
100
Summit Medical Center
Crawford, AR
103
Haskell County Community Hospital
Haskell
25
Eastern Oklahoma Medical Center
LeFlore
84
Muskogee Community Hospital, LLC
Muskogee
45
Muskogee Regional Medical Center
Muskogee
255
Sparks Regional Medical Center
Sebastian, AR
510
St. Edward’s Mercy Medical Center
Sebastian, AR
336
Figure 1
Sallisaw, Oklahoma Medical Service Area
Secondary Service Area
Primary Service Area 3
Table 1
Sallisaw, Oklahoma Medical Service Area Population by Zip Code
Estimated 2009 Population
Totals
Primary Medical Service Area
74955, Sallisaw
13,689
74948, Muldrow
10,510
74962, Vian
7,258
31,457
Secondary Medical Service Area
74435, Gore
1,478
74954, Roland
8,873
10,351
Medical Service Area Total
41,808
Source: ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions
The number of physician office visits generated in the Sallisaw, Oklahoma service area was estimated using the service area population data and research on the number of annual physician office visits for a specified age group [1, 2, 3]. Age group breakouts (by gender) and their corresponding number of annual physician office visits are presented in Table 2. For instance, for males under age 15, the average number of physician office visits is 2.6 visits per year [3]. Males between 15 and 24, however; make only 1.1 visits per year. Similar estimates are applied to other age groups to derive the total number of physician office visits occurring in the Sallisaw medical service area. Residents in the primary medical service area were estimated 4
to make 99,227 total physician office visits per year, while residents of the secondary medical service area were estimated to visit physicians 33,172 times annually (Table 2). Of these total physician office visits, recent data indicates that 58.3 percent will be made to physicians active in primary patient care while the remainder will be made to specialists [3]. Using the data presented in Table 2, the primary medical service area will generate 57,850 primary care physician visits (58.3% x 99,227), and the secondary medical service area will generate 19,339 visits (58.3% x 33,172) yielding a total of 77,189 local primary care physician visits per year for the total medical service area.
The total number of primary care physician office visits given various usage rates is presented in Table 3 for the Sallisaw medical service area. If there is a 90 percent usage of Sallisaw primary care physicians by residents of the primary medical service area and a 10 to 15 percent usage rate from residents in the secondary service area, an estimated 53,999 to 54,966 primary care physician office visits will be made annually in the Sallisaw medical service area. The national average for the number of annual office visits to each primary care physician is 4,870 [4]. Therefore, Sallisaw needs an estimated 11.1 primary care physicians at a 90 percent primary medical service area usage rate coupled with a 10 percent usage rate from the secondary medical service area (53,999/4,870 = 11.088). By expanding the secondary usage rate to 15 percent, the need becomes 11.3 total primary care physicians (54,966/4,870 = 11.287). Higher usage levels would indicate that more physicians could be supported, while lower usage levels would indicate fewer physicians could be supported.
All assumptions and local conditions, including the actual usage levels in the primary and secondary medical service areas must be taken into consideration by decision-makers before determining if additional physicians could successfully locate in Sallisaw, Oklahoma. Some Sallisaw residents may be hesitant to leave their current physician, even if they are in another 5
town. Further, the current number of existing primary care physicians is not included in this analysis. Any evaluation of the relative shortage or surplus of primary care physicians must include details about the current levels of practicing physicians. Again, primary care physicians include the physician practices of internal medicine, pediatrics, family medicine, and OB-GYN. All of these types of physicians should be considered when analyzing the usage levels in the medical service area.
Summary
The analysis above presented the methodology and results of estimating the demand for primary care physicians in Sallisaw, Oklahoma. The results suggest that, given a 90% primary service area usage rate and a 10% secondary service area usage rate, an estimated 11.1 primary care physicians can be supported in the Sallisaw area. The actual number of physicians that the Sallisaw medical service area can support will vary based on the usage rates depicted in Table 3. Estimates of these usage rates should be used in conjunction with the current status of the primary care industry in Sallisaw to determine the next steps for the community.
Many assumptions have been made in this analysis. These include items that may change, such as the population of the service area or service area delineation. For example, the service area depicted here may change due to the exit or entry of physicians from nearby communities. If this does occur, revised estimates of physician office visits should be made. The number of existing primary care physicians is not addressed in this study. A close examination of current practicing primary care physicians will be imperative to accurately assess whether or not the current population base can in fact support additional primary care physicians.
All assumptions should be closely examined by local decision-makers to verify that they reflect local conditions. If additional local data are available, they should be included to derive the 6
most realistic conclusion possible for the current situation. If further analysis is needed, contact your county extension office listed on the title page of this document.7
Table 2
Annual Primary Care Physician Office Visits Generated in the Sallisaw, Oklahoma, Medical Service Areas
PRIMARY MEDICAL SERVICE AREA
Male
Female
2009
Visit
2009
Visit
Total
Age
Population
Rate1
Visits
Population
Rate1
Visits
Visits
Under 15
3,311
2.6
8,608
3,185
2.6
8,281
16,890
15-24
2,418
1.1
2,659
2,167
2.4
5,201
7,860
25-44
4,115
1.6
6,584
4,083
3.2
13,065
19,649
45-64
3,869
3.0
11,608
4,066
3.9
15,858
27,467
65-74
1,041
5.5
5,723
1,222
6.0
7,332
13,055
75+
748
7.1
5,314
1,232
7.3
8,993
14,307
Total
15,502
40,497
15,955
58,731
99,227
Primary Medical Service Area - Local Primary Care Physician Office Visits Per Year:
57,850
SECONDARY MEDICAL SERVICE AREA
Male
Female
2009
Visit
2009
Visit
Total
Age
Population
Rate1
Visits
Population
Rate1
Visits
Visits
Under 15
1,089
2.6
2,833
1,048
2.6
2,725
5,558
15-24
796
1.1
875
713
2.4
1,711
2,586
25-44
1,354
1.6
2,166
1,344
3.2
4,299
6,466
45-64
1,273
3.0
3,820
1,338
3.9
5,218
9,038
65-74
342
6.2
2,123
402
6.7
2,694
4,817
75+
246
7.1
1,749
405
7.3
2,959
4,708
Total
5,101
13,565
5,250
19,607
33,172
Secondary Medical Service Area - Local Primary Care Physician Office Visits Per Year:
19,339
Source: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center of Health Statistics, "National Ambulatory Medical Care Survey: 2006 Summary," No. 3, August, 2008
8
Table 3
Primary Care Physician Office Visits Given Usage
By Local Residents in Sallisaw, Oklahoma Medical Service Areas
Usage by Residents of Primary Service Area
70%
75%
80%
85%
90%
95%
100%
Usage by Residents of Secondary Service Area
5%
41,462
44,354
47,247
50,139
53,032
55,924
58,817
10%
42,429
45,321
48,214
51,106
53,999
56,891
59,783
15%
43,396
46,288
49,181
52,073
54,966
57,858
60,750
20%
44,363
47,255
50,148
53,040
55,932
58,825
61,717
25%
45,330
48,222
51,114
54,007
56,899
59,792
62,684
30%
46,297
49,189
52,081
54,974
57,866
60,759
63,651
35%
47,263
50,156
53,048
55,941
58,833
61,726
64,618
40%
48,230
51,123
54,015
56,908
59,800
62,693
65,585
45%
49,197
52,090
54,982
57,875
60,767
63,660
66,552
50%
50,164
53,057
55,949
58,842
61,734
64,627
67,519
If 90% primary medical service area and 10to 15% secondary medical service area, then the usage would be:
9,557 to 11,035 total primary care physician office visits
for an estimated 11.1 to 11.3 Total Primary Care Physicians
Based on 4,870 average annual primary care office visits per physician practice in Oklahoma [4] 9
References
[1] “Family Medicine – A Systematic Approach to the Planning and Development of a Community Practice,” Doeksen, G., Miller, K.A., Shelton, P.J., and Miller, D.A., University of Oklahoma Health Sciences Center, 1990.
[2] "Internal Medicine - A Systematic Approach to the Planning and Development of a Community Practice - A Step-by-Step Guide," Miller, K.A., Doeksen, G., Miller, D., Campbell, J., and Shelton, P.J., University of Oklahoma Health Sciences Center, 1993.
[3] U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center of Health Statistics, "National Ambulatory Medical Care Survey: 2006 Summary," No. 3, August, 2008.
[4] Physician Socioeconomic Statistics. American Medical Association, Center for Health Policy Research. Eds Wassenaar, JD, and SL Thran. 2003. American Medical Association: United States.
[4] ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.